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  <title>第二届中欧多学科咬合论坛听课记录 | 赵瑜敏的口腔医学专业学习博客</title>
  








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          <h1 class="post-title" itemprop="name headline">第二届中欧多学科咬合论坛听课记录</h1>
        

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        <p>还是听网课。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0230-yaohe/01%20%5B2%5D.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0230-yaohe/02%20%5B2%5D.png"></p>
<p>儿童早期咬合诱导应考虑的问题与方法<br>北大 葛立宏<br>为何早期咬合诱导？避免成人的减数矫治。<br>争议：<br>①多数需要第二阶段治疗——解决咬合、面型的问题<br>②延长治疗时间<br>③可能对患者的生长型有害<br>④诊断和治疗计划的不确定性。<br>利用生长期优势进行干预。<br>颌骨更协调生长。<br>治疗结果更稳定。<br>改善面部美观。<br>提高自信心，心理健康发展。<br>相对容易去除口腔不良习惯。<br>避免前突造成外伤。<br>提供更好的间隙管理。<br>引导恒牙萌出和替换。<br>降低恒牙期拔牙的可能性。<br>降低第二阶段治疗难度。<br>什么是早期矫治？乳牙列期和混合牙列期对咬合进行早期最小化干预，创建良好的“牙合”发育环境。<br>主要目标：<br>①促进牙及颌骨的正常发育。<br>②消除或控制不良环境因素对正常牙合的影响。<br>③为正常牙合建立营造一个良好的环境。<br>④纠正或引导正常牙合发育。<br>⑤消除或减少二期治疗的可能<br>⑥最大化的应用生长潜力。<br>时机<br>①正畸筛查应在4-5岁开始。<br>②早期矫治可在第一恒磨牙和切牙萌出后开始。<br>咬合发育的影响因素：遗传+环境<br>不良习惯：吐舌，吮指，口呼吸等。<br>环境因素：乳牙早失、乳牙滞留、牙-牙弓形态不调、萌出异常、不良口腔习惯、颅-颌骨异常。<br>早期咬合诱导应考虑的因素<br>错颌畸形形成原因<br>从牙齿、肌肉、颌骨三方面思考早期矫治策略。<br>内容与方法<br>①去除影响因素。<br>②儿牙医生应检查牙齿、牙列、面部发育。<br>③注意五官发育。<br>④肌功能治疗+牙齿排齐。<br>②儿牙与正畸医生协调配合。<br>预防：发现和去除不利因素。<br>引导：引导恒牙正常萌出和颌骨正常生长。<br>阻断：去除早期畸形和不良习惯，阻断不良习惯进一步发展。<br>没有一种方法或工具可以解决所有早期矫治问题。<br>常见问题：①口腔习惯；②发育异常；③牙量骨量不调（三维的）；④间隙管理（保持、获得）；⑤错颌畸形。<br>提问：推荐书籍。儿牙就医指南。</p>
<p>种植固定修复咬合设计与调颌细节<br>北大口腔医院 孙凤<br>听听了。<br>正中咬合：调高点与非理想咬合点。<br>自由正中咬合：正中颌附近小幅度运动，所有牙都接触。超过该范围才是侧方前伸咬合。<br>功能尖受力兼顾沿着种植体为中心平衡受力。<br>正中用红色咬合纸调，非正中用蓝色咬合纸调。因为正中咬合调的次数多，如果用红的调非正中，如果没看到，会有问题。<br>不调非正中干扰，会有避让运动等问题。<br>大多数能自己适应，但会有少数出大问题。<br>咬合设计原则：<br>①消除咬合超载与咬合干扰<br>②渐进性负重<br>③尽量轴向受力，减少水平分力<br>④功能尖受力兼顾沿种植体中心平衡受力<br>⑤兼顾植体与周围骨的条件。<br>咬合分类<br>按咬合功能大小（正中状态咬合）<br>咬合超载：咬合力点只在修复体上/出现空咬合点（周围有点，中央没有）/出现过多咬合点。<br>正常咬合：咬合点3、5、7个均可。咬合点轻重支撑牙齿的垂直距离，咬合点分布维持牙齿基本稳定。正常咬合点大小，0.5-1mm<br>轻咬合：正中咬合力小于原有天然牙，垂直向咬合力点轻，点的面积小于邻牙。<br>无咬合：200μm咬合纸无印记。<br>按种植修复体是否支撑垂直距离<br>种植体支撑——上可调牙合架，正常咬合。<br>非种植体支撑——上（或不上）牙合架，轻咬合。<br>部分种植体支撑——上（或不上）牙合架，种植体数量多为正常咬合，否则为适中轻咬合。<br>咬合纸厚度的选择：种植体常设计为轻咬合与适度轻咬合，采用<br>薄：厚 约40:80μm<br>薄：厚 约80:200μm<br>调颌顺序：<br>正中咬合<br>正中自由度<br>非正中：前伸与侧方不分顺序。非工作侧不能有干扰点。<br>咬合设计的条件是：印模精准、牙合关系精准。<br>种植体也会移位，要复查咬合。<br>单侧种植，垂直距离的咬合上参考对侧，咬合点数量小于等于对侧天然牙。<br>螺丝固位的种植体患者建议不要吃侧向力太大的食物，降低螺丝松动概率。<br>轻咬合的定义：是相对的概念，比正常咬合轻，又有咬合。轻咬合是边缘嵴不能低，与邻牙形成台阶的话容易形成食物嵌塞。<br>多颗牙缺失种植修复，为何用单冠而不是连冠？天然牙是分开的，如果能以最小单位修复，就以最小单位。现在种植骨结合和修复体均很可靠了。</p>
<p>咬合重建中颌位关系转移的方法和操作细节详解<br>北大口腔医院 刘云松<br>也是听听而已了。<br>1.难<br>知识面广，目前临床常用的理论就有7种。<br>治疗过程步骤多:检查设计阶段（口内检查、关节检查、影像检查、方案设计）、口腔准备阶段（外科、牙体、牙髓、牙周）、颌位调整阶段（治疗性颌位、牙合垫试错、调颌、MockUp）、临时修复阶段（临时冠、调牙合、关节预测、美学沟通）、永久修复阶段（颌位确认、颌位转移、修复体制作、临床调改）、随访维护阶段（牙周维护、复查咬合、咬合调整、再制作）。<br>须有临床经验的积累。<br>全面系统检查分析。<br>周密的治疗计划。<br>注重细节、精准实施。<br>经验不足，先不要动手做咬合重建。<br>2.多学科<br>几乎涉及所有口腔学科。<br>关节检查：肌肉、压痛、弹响、开口度及下颌运动(在牙面上划线）。<br>在口内用自凝塑料做临时冠，是不可能坚持太久的。<br>千万别害怕患者回来找你，是教你东西呢。<br>多学科不是一个人掌握所有学科。要了解相关学科的基础知识和基本原则。（知道能做到什么，做不到什么。规避风险。）<br>咬合病可以做，关节病不能做。<br>很多修复医生遇到的所谓疑难病例，仔细分析都不是修复治疗的适应证，或者说修复治疗并不是这一类病例的首选治疗方案。<br>要关注精神心理问题。<br>3.转移<br>最适合的位置不是医生定出来的（医生不是上帝），是试出来的，是患者自己磨耗出来的。修复医生要做的是把最适合的位置转移出来。<br>确定上下颌位置关系的方法：Lucia Jig、双手操作法、OSU Woefel Gauge、Leaf Gauge。<br>修复时分两段法，左右分开做。<br>咬合记录：用上颌临时冠取下颌的咬合记录，然后取一侧上下颌的咬合记录，最后用下颌临时冠取上颌咬合记录。<br>上颌架。<br>要和患者沟通好。《医学的温度》。<br>(看到第4小时）</p>
<p>只能到这了，看了头一个半天的，本来想随后再看，结果今天再点开，观看回访要密码了……好在精华都讲了，接下来是颞下颌关节的内容了。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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